Oluwagbemiga Oluwole Ayoola

Sonographic Evaluation of Structural Changes in Post-Stroke Hemiplegic Shoulders

Summary Background Stroke and hemiplegia are frequent complications of stroke. This study was performed to sonographically evaluate post-stroke hemiplegic shoulders and explore possible relationship(s) between the sonographic findings and clinical indices. Material/Methods Forty-five stroke patients and 45 age- and sex-matched controls were recruited. Standard sonographic examination of both shoulders was performed to assess for joint subluxation, rotator cuff tears, tendinosis, subacromial-subdeltoid bursitis or effusion and adhesive capsulitis. Results Hemiplegic shoulders exhibited significantly higher number of pathologies compared to the unaffected shoulders and shoulders of controls (p=0.000). One or more structural abnormalities were found in all 45 (100%) hemiplegic shoulders, 25 (55.6%) unaffected shoulders of the stroke subjects, and 39 (43.3%) control shoulders. The most frequent pathologies in the hemiplegic shoulders were the following: tendinosis of the long head of bicep tendon (48.9%), inferior shoulder subluxation (44.4%), co-existing subacromial-subdeltoid bursa/long head of bicep tendon sheath effusion (44.4%), and long head of bicep tendon sheath effusion only (40%). Tendinosis of the long head of bicep tendon was commoner in hemiplegic shoulders with poor motor status than those with good motor status. Conclusions Hemiplegic shoulders have significantly higher number of structural abnormalities than unaffected shoulders and the shoulders of controls. Hemiplegic stroke patients should undergo ultrasonography of the hemiplegic shoulder to define the nature and extent of soft tissue injuries prior to physical therapy.

Sonographic Evaluation of Endothelial Function in Brachial Arteries of Adult Stroke Patients

Brachial artery flow‐mediated dilatation on sonography is used to evaluate endothelial dysfunction, which is a key event in the development of atherosclerosis and predates structural atherosclerotic lesions by many years. Atherosclerosis has been implicated in the pathophysiologic mechanisms of ischemic stroke. The aim of this study was to determine the association between brachial flow‐mediated dilatation, the presence of cardiovascular risk factors, and acute stroke.

Sonographic assessment of the carotid intima-media thickness on B-mode ultrasonography in a Nigerian population

Background: Hypertension is a common health problem and a major risk factor of cardiovascular disease. The most important mechanism by which hypertension acts as a cardiovascular risk factor is the induction of arteriosclerosis. The early phase of atherosclerosis before its clinical manifestation can be studied using B-mode ultrasonography. Aims and Objectives: This study evaluated the intima-media thickness of the common carotid artery (CCA), carotid intima-media thickness (CIMT) of subjects with essential hypertension as a way of detecting these early changes of atherosclerosis. Subjects and Methods: The study was performed on 200 subjects with newly diagnosed hypertension and 100 apparently normal controls that were consecutively recruited by a cardiologist. An ultrasound examination of both CCA were done to obtain the CIMT. Data were analyzed using the SPSS data analysis software. Results: The CIMT of males were greater in the hypertensive group compared to the controls (0.10 ± 0.02 cm vs. 0.077 ± 0.02 cm [P < 0.0001] and 0.10 ± 0.02 cm vs. 0.078 ± 0.02 cm [P < 0.0001] for the right and left sides, respectively). The female group showed a similar pattern of results (0.09 ± 0.02 cm vs. 0.072 ± 0.02 cm [P < 0.0001] and 0.1 ± 0.02 cm vs. 0.076 ± 0.02 cm [P < 0.0001] for the right and left sides respectively). Conclusion: A statistically significant increase in CIMT was noted in both male and female hypertensives in comparison to a normal population.

Variations of renal vascular anatomy in a Nigerian population: A computerized tomography study

Background: A broad spectrum of renal vascular variations has been reported by anatomists and radiologists. The prevalence of these variations is extremely divergent in different populations. Therefore, radiologists and surgeons in different climes must be knowledgeable about the type and prevalence of the variants in their area of practice to avoid diagnostic pitfalls and for optimization of surgical techniques. Objective: The objective of this study is to describe the types and prevalence of renal vascular variations among patients undergoing contrast-enhanced computerized tomography (CECT) of the abdomen in a Nigerian population, as well as provide a concise review of literature on the embryological basis and clinical significance of the identified variations. Materials and Methods: This study was a retrospective review of 200 CECT of the abdomen to identify variations of arterial (accessory, early branching, and precaval) and venous (multiple, retroaortic, and circumaortic) anatomy of the kidneys. Results: We studied 200 patients, 102 (51%) females and 98 (49%) males. Age range is 18–90 years (mean = 53.08 ± 17.01). Prevalence of any renal vascular variations was 50%, arterial variations were 37%, and venous variations were 13%. Variations were significantly more common in males, P = 0.000075. The most common arterial variant was the accessory renal artery (23%) seen in 10% (right) and 13.0% (left); early branching was seen in 4.0% (right) and 0.5% (left) as well as precaval right renal artery seen in 4.5%. Venous variants were late confluence 3.0% (right) and 2.5% (left); multiple veins was seen in 2.5% (right) and 2.5% (left) as well as retroaortic left renal vein seen in 2.0%. The inferior polar accessory artery was the most prevalent accessory artery. Early arterial bifurcation was significantly more common on the right (P = 0.016) while other vascular variants showed no statistically significant association with laterality. Conclusion: Variation of renal vascular anatomy is a frequent finding among Nigerians. Radiologists and surgeons must be aware of these variants for optimization of surgical techniques.

Hepatobiliary Ultrasonographic Abnormalities in Adult Patients with Sickle Cell Anaemia in Steady State in Ile-Ife, Nigeria

Summary Background Sickle cell anaemia (SCA) is associated with structural manifestations in the hepatobiliary axis. This study aimed to investigate the hepatobiliary ultrasonographic abnormalities in adult patients with sickle cell anaemia in steady state attending the Haematology clinic of a federal tertiary health institution in Ile-Ife, Nigeria. Material/Methods Basic demographic data as well as right upper abdominal quadrant ultrasonography of 50 consecutive sickle cell anaemia patients were compared with those of 50 age- and sex-matched subjects with HbAA as controls. Results Each of the study groups (patients and controls) comprised of 21 (42%) males and 29 (58%) females. The age range of the patients was 18–45 years with a mean (±SD) of 27.6±7.607 years, while that of the controls was 21–43 years with a mean (±SD) of 28.0±5.079 years (p=0.746). Amongst the patients, 32 (64%) had hepatomegaly, 15 (30%) cholelithiasis and 3 (6%) biliary sludge. Fourteen (28%) of the patients had normal hepatobiliary ultrasound findings. In the control group, one (2%) person had cholelithiasis, one (2%) biliary sludge, one (2%) fatty liver and none hepatomegaly. Forty-seven (94%) of the controls had normal hepatobiliary ultrasound findings. There was a statistically significant difference in the prevalence of hepatomegaly and cholelithiasis between the patients and controls (p value <0.001 for both comparisons). Conclusions In this study, hepatomegaly, cholelithiasis and biliary sludge were the most common hepatobiliary ultrasound findings in patients with sickle cell anaemia. Ultrasonography is a useful tool for assessing hepatobiliary abnormalities in patients with sickle cell anaemia.

Clinical Audit of Paediatric Magnetic Resonance Imaging Under Sedation at a Nigerian Tertiary Institution

Summary Background Magnetic resonance imaging (MRI) in paediatric patients requires them to be calm during the procedure to avoid motion artefacts in the acquired images. Sedation and/or anaesthesia is a way to achieve this. We evaluated all paediatric MRI sedations since installation of an MRI device in our hospital. Material/Methods We retrospectively reviewed 69 paediatric MRI sedations performed over a 5-year period using records of patients’ biodata, MRI date, indication, findings and scan time, sources of referral, body region scanned, type, dose, related adverse events and route of administration of sedatives as well as image quality. Results The median age and weight of the patients were 24 months {range of 0.3 months (10 days) to 132 months (11 years)} and 11.5 kg (range of 2.6 kg to 42 kg), respectively. Males constituted 50.7% of the patients. Most participants (94.2%) were in-patients of the hospital, mainly (60.0%) referred from the paediatric unit, with slightly over one third (36.2%) of the studies performed in 2015. The commonest indication and scanned body region were macrocephaly (18.8%) and the brain (76.8%), respectively. Hydrocephalus (17.4%) was the commonest MRI finding. Sedation was planned in 66 (95.7%) patients and was successful in 68 (98.6%). Midazolam and the IV route were the commonest sedative agent and route of administration, respectively. Image quality determined by age was fair to good in 68 (98.6%) patients with only 1 patient requiring re-scanning due to motion blur. No adverse events with sedation were recorded. Conclusions Midazolam via the IV route with or without oral route is the drug of choice for MRI sedation in children in our institution with a success rate of about 99%.

Uterine artery Doppler velocimetry in hypertensive disorder of pregnancy in Nigeria

Aim of the study To evaluate the value of uterine artery Doppler indices and waveform pattern in predicting fetuses at risk for intrauterine growth restriction in hypertensive disorders of pregnancy. Materials and methods This was a prospective cross-sectional study including 80 pregnant subjects with hypertensive disorders of pregnancy and two control groups. Uterine artery Doppler sonography was performed in all study participants. Uterine artery Doppler indices across the groups were compared using the analysis of variance (ANOVA) while the presence of prediastolic notch was analyzed with the Chi Square test. Results For the hypertensive disorders of pregnancy group, resistivity index > 0.66 had a sensitivity of 50.0%, specificity of 69.1% and a positive predictive value of 22.2% for predicting intrauterine growth restriction. The odds ratio was 2.2 with a 95% confidence interval of 0.6–7.8. The presence of prediastolic notching had a sensitivity of 100.0%, specificity of 96.0% and a positive predictive value of 80.0% for predicting intrauterine growth restriction. The odds ratio was 22.7 with a 95% confidence interval of 7.5–68.5. Conclusion Uterine artery Doppler sonography is useful for predicting fetuses at risk for intrauterine growth restriction in hypertensive disorder of pregnancy. Prediastolic notching is more sensitive and more specific than uterine artery resistivity index in predicting fetuses at risk of intrauterine growth restriction in established hypertensive disorder of pregnancy.

Sonographic detection of inferior subluxation in post-stroke hemiplegic shoulders

Aim of the study To evaluate the usefulness of ultrasonographic acromion-greater tuberosity distance measurement and Shoulder ratio in detecting post-stroke inferior shoulder subluxation. Material and methods Forty-five hemiplegic stroke patients and 45 controls underwent shoulder sonography to measure their acromion-greater tuberosity distance. Side-to-side acromion-greater tuberosity distance differences and Shoulder ratios were derived from the acromion-greater tuberosity distance values. The long head of biceps tendon, subscapularis tendon, supraspinatus tendon, and the infraspinatus tendon were also evaluated to exclude full thickness tendon tears. Data were analyzed using the Statistical Package for Social Sciences version 20.0 for windows. Normality of data distribution was checked using the Kolmogorov–Smirnov test. Mann–Whitney U test and Chi-square tests were utilized. Results Hemiplegic and control shoulders’ acromion-greater tuberosity distance values were 2.8 ± 0.6 cm and 2.4 ± 0.4 cm, respectively (p = 0.001). Hemiplegic and control shoulder ratios were 1.3 ± 0.3 and 1.1 ± 0.1, respectively; p < 0.001. Point biserial correlation showed that the presence of subluxation correlated moderately with higher shoulder ratios in all the hemiplegics (rpb = 0.520; p < 0.001). Conclusion Our results suggest that acromion-greater tuberosity distance measurement is useful for detecting inferior shoulder subluxation. Shoulder ratio may be of complementary or supplemental value to acromion-greater tuberosity distance difference.

Sedation practice among Nigerian radiology residents

Background: Providing safe and effective sedation to patients, especially those with multiple medical problems, can be challenging for radiology residents and fellows. This study aimed to determine knowledge, attitude and practice of Nigerian radiology residents concerning sedation.

Normogram of umbilical artery Doppler indices in singleton pregnancies in south‐western Nigerian women

To determine the Doppler indices of the umbilical arteries in normal singleton pregnancy with a view to generating local reference ranges.